Back to Basics: Lumbar Discogenic Pain

Spine & Nerve

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves go back to basics and introduce the topic of lumbar discogenic pain. Lumbar discogenic pain is defined as a painful disease process due to compromise of the lumbar disc and is very common, with most studies documenting that around 40% of low back pain is predominantly due to discogenic pain. Disc degeneration is part of the natural degenerative cascade of the spine, but can be more advanced and lead to significant symptoms and impairments. Discogenic pain is often characterized by centralized low back pain that tends to be worse with forward flexion (ie bending at the waist) and sitting (especially with vibration like in a car). MR Imaging can show internal disc disruption, annular fissures, and modic changes. Risk factors for disc degeneration and discogenic pain include aging, genetics, obesity, and smoking. Smoking and weight, are modifiable risk factors that should be emphasized and addressed when applicable. Though the disc itself can be painful, if the disc puts pressure on other structures (like the nerve roots) it can cause different pain patterns. Listen as the doctors talk through this important topic, and dive into the basic science behind disc degeneration, as well as emphasize certain important concepts including but not limited to Modic changes. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Nikolai Bogduk, MD, Charles Aprill, MD, Richard Derby, MD, Lumbar Discogenic Pain: State-of-the-Art Review, Pain Medicine, Volume 14, Issue 6, June 2013, Pages 813–836. 2. Sertac Kirnaz, MD, et al. Pathomechanism and Biomechanics of Degenerative Disc Disease: Features of Healthy and Degenerated Discs. International Journal of Spine Surgery. 2021.